New rule limits narcotic painkiller prescriptions to seven days

Ohio doctors, dentists and some nurses will be unable to prescribe more than seven days of narcotic pain killers — five days for minors — under rule changes announced today by Gov. John Kasich.

The prescribing restrictions, which will have the force of law, apply to acute pain patients. They are estimated to reduce the number addictive pain pills dispensed statewide by 109 million annually, and, more important, to save lives.

Medical personnel who don’t follow the rules will be in danger of losing their license, Kasich said at a Statehouse news conference. The rules are not expected to take effect until this summer.

“You are going to have to abide by these rules or else you’re in serious trouble, whether you’re a doctor, a dentist or a nurse,” he said.

Kasich said tightening prescribing rules is part of Ohio’s multi-faceted approach to fighting a deadly scourge of drug abuse, which took a record 3,050 lives through overdoses in 2015.

“We’re paying the price now for a lot of the neglect we had in the past,” Kasich said of the state response to the drug epidemic.

“We’re winning the battle but we have a long way to go to winning the war … This is one of those issues that, thank God, supersedes party and philosophy.”

The new rules follow a series of restrictions on pain pills beginning in 2012. Overall, the previous restrictions cut down pills prescribed in Ohio by 20 percent, or 162 million doses, from 2012 to 2016.

Prescriptions now can be written for 30 to 90 days of painkillers.

Health experts say prescription opioids are most often the gateway to addiction, with three of four people who died from a drug overdone in 2015 previously having been prescribed an opioid pain pill, such as OxyContin. Many, especially young people, get their first narcotic pain pills from prescriptions unused by family and friends.

In addition to the pill limits, the new rules will require doctors to provide a specific diagnosis or procedure code on every prescription written for a controlled substance. The limits apply to acute pain, such as after surgery, dental work, broken bones, sprains and other ailments that heal. They will not apply to cancer patients, palliative and hospice care and medication-assisted treatment for people dealing with addictions.

The rules will be enacted by the Ohio Board of Pharmacy, the State Medical Board, the Dental Board and the Board of Nursing. However, the process is expected to take several months because the rules must be reviewed by the Joint Committee on Agency Rule Review, a legislative panel.

It is the fourth step the state has taken restricting pain pill prescriptions. Rules were enacted for emergency rooms in 2012, chronic pain guidelines were issued in 2013, and acute care care guidelines released last year. Today’s action upgrades restrictions on acute pain prescribing from guideline to legal requirement.

Ohio officials have struggled to deal with the rising tide of overdose deaths. The total is expected to be much higher once 2016 numbers are tallied.

Dr. Mark Hurst, medical director of the state Department of Mental Health and Addiction Services, said Kasich’s idea is to dramatically reduce the number of pills prescribed unnecessarily.

“Every unused pill is an opportunity for someone to take that pill inappropriately,” Hurst said. He said the state worked with medical organizations to avoid breaching doctors’ professional judgement about when to prescribe and not to prescribe painkillers. He said doctors will have flexibility to exceed the rule if they provide documented reasoning.

Attorney General Mike DeWine released a statement supporting Kasich’s action: “Every day in Ohio we lose eight people to drug overdoses. This number is as unacceptable as it is tragic … I believe we can take proactive steps to fight the scourge of drug addiction that is affecting so many of Ohio’s families, while providing treatment for patients in need.”

Kasich’s announcement comes a day after Republican lawmakers proposed legislation to require doctors to follow federal Centers for Disease Control guidelines limiting acute pain prescriptions to three days, or up to seven days if the doctor goes through training in alternatives and offers treatment options.

House Speaker Cliff Rosenberger, R-Clarksville, promised to forge a “partnership between the legislature and the governor” on the subject. “At the end of the day, it’s about the families of the state of Ohio.”

The Ohio State Medical Association, representing doctors, called the legislative proposal too rigid. An official said the association thinks Kasich’s rules offer doctors more flexibility.